<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    <div style="text-align: center;font-size: 30px;margin-bottom: 30px">确认退款信息</div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('三方单号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sanfang" class="form-control" readonly name="row[sanfang]" type="text" value="{$row.sanfang|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('退款单号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_no" class="form-control" readonly name="row[order_no]" type="text" value="{$row.order_no|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('退款金额')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-money" class="form-control" readonly name="row[money]" type="text" value="{$row.money|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
